ADHD & Hormones in Women: How Estrogen Changes Your Symptoms

Written by Cheryl Gigler
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Hormonal fluctuations heavily influence ADHD symptoms in women because there is a direct correlation between estrogen and dopamine levels.

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What is Estrogen?

Estrogen is the hormone responsible for the sexual and reproductive development of girls and women. It manages important neurotransmitters, or brain chemicals, including dopamine, which is central to executive functioning as well as serotonin, which regulates mood and supports memory. All women are affected by shifting levels of estrogen, but women with ADHD are more severely impacted. 

One study in 2023 showed that women experience increased ADHD symptoms as well as a reported decrease in ADHD medication effectiveness. Another 2023 study showed that risk taking behaviors may increase mid-cycle and that inattentive symptoms increased just prior to the start of the menstrual cycle.

To sum it up, estrogen levels impact dopamine. When estrogen drops, ADHD symptoms become worse and stimulant medications can feel less effective.

What are the Major Life Stages Impacted by Hormonal Fluctuations?

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The Menstrual Cycle

On the first day of a woman’s period, the follicular phase, rising estrogen levels sharpen focus, increase alertness and help working memory (days 1-14). In general, women experience better mood and executive skills. This continues until ovulation.

The final phase of the menstrual cycle, the luteal phase, lasts until a woman’s next period begins. During this phase, dropping estrogen and rising progesterone, impact attention and the ability to regulate emotions. Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder, (PMDD) affect women with ADHD at greater rates than the general population.

According to a recent survey of women in ADDitude magazine, nearly 2/3 of women with ADHD reported experiencing PMS or PMDD.

Because the neurotransmitter dopamine is already lower in women with ADHD, the hormonal dip causes ADHD symptoms and premenstrual symptoms to amplify each other, hence the “premenstrual crash.” Executive functions are more intense, making areas such as starting a task, planning, organizing thoughts or managing time much harder. Inattention, memory issues, impulsivity, hyperactivity, exhaustion and sleep may become worse.

Women with ADHD are also more likely to experience Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS. PMS may include irritability and physical discomfort but PMDD can bring intense rage, a sense of hopelessness, severe anxiety or episodes of depression that disrupt daily life.

Illustration of a woman with a cloud over her head, depicting brain fog

Puberty

During puberty, the natural spikes and drops in estrogen and progesterone can make ADHD symptoms more obvious leading to diagnosis. This might look like extreme emotional volatility, heightened anxiety and depression, extreme brain fog, time blindness, ADHD “task paralysis”, spikes in impulsivity, sensory overload, exhaustion and sleep issues.

Pregnancy

During pregnancy there is an extreme rise in both estrogen and progesterone. This can create a pleasant change for women with ADHD. ADHD stabilizes and significantly improves in the first two trimesters.

However, in the third trimester, difficulty with sleeping comfortably can impact memory and attention. The physical toll of carrying the pregnancy can overwhelm the brain’s executive functioning system as well as the increase in anxiety regarding labor.

Postpartum

Within 48 hours of giving birth, estrogen and progesterone levels drop dramatically back to baseline, which causes a severe and rapid drop in dopamine. Women with ADHD are at a significantly higher risk for postpartum depression (PPD), and postpartum anxiety, as ADHD brains are highly sensitive to the sharp drop in dopamine.

Perimenopause and Menopause

During perimenopause and menopause there is a steady decline in estrogen and progesterone. The primary driver behind this shift is the relationship between estrogen and dopamine. Estrogen acts like a booster for dopamine and serotonin in the brain, sharpening focus, memory and emotional stability. Many women experience brain fog and memory issues, contributing to sensory overload, overwhelm, irritability, frustration, anxiety or depression. Add to that menopausal hot flashes, night sweats and insomnia. Sleep deprivation dramatically impacts the ADHD brain. This is another time where many women receive their first ADHD diagnosis. When estrogen drops sharply, ADHD symptoms go into overdrive!

Medication and Treatment Adjustments

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Log your symptoms so that you can predict when mood shifts happen                 

Talk to a healthcare provider about the possibility of medication adjustments prior to your monthly cycle and check out hormone replacement therapy during perimenopause and menopause.

Schedule downtime when you know that you are most impacted by estrogen drops, such as before your monthly cycle or after giving birth.

Externalize your systems by using timers, visual scheduling - such as Skylite or a white board, and automated reminders.

Get moving as exercise is extremely important! It naturally triggers dopamine levels in the brain.

Check out this ADDitude Magazine Guide to PMS and ADHD: How the Menstrual Cycle Intensifies Symptoms, or the ADDA overview on PMDD and ADHD: Understanding the Connection and Managing Symptoms.

When estrogen drops, ADHD symptoms become worse and stimulant medications feel less affective. This awareness can make a huge difference in ADHD treatment, as ADHD touches every area of life. And with awareness comes choice. More research can ensure better outcomes for girls and women with ADHD across the entire lifespan. Until that time, be your own advocate! 

Resources

Cheryl Gigler
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